Readiness for the scorecard era in cardiovascular medicine

In the midst of health care reform that has been largely fueled by the escalating and runaway costs of medical care, there is clearly going to be a major emphasis on documentation of quality of care, the likes of which we would not have conceived a few years ago, and for which we remain quite ill prepared for today. Accountability in the practice of medicine will increase substantially in the years ahead because of the need to provide the best care for the least cost. Outcome-effectiveness research activities have assumed increasing importance and will provide some of the methodologic basis for defining standards of quality. The field of cardiology, which is dominated by multiple procedures with outcome measures available and which accounts for a substantial portion of health care cost, is an attractive target for outcome-effectiveness evaluation. Indeed, in the introduction of the Health Security Act by President Clinton to Congress and the public, the need for “report cards” was cited. The specific report of the Pennsylvania Health Care Cost Containment on coronary artery bypass graft surgery (CABG) has been mentioned as a model by which improvement in cost-effective medicine can be delivered in the future. 1,2 In cardiology, percutaneous coronary intervention procedures are quite analogous to coronary bypass surgery operations, beyond their similar goal of achieving myocardial revascularization. Both are characterized by high costs, a relatively high frequency of adverse outcomes, and marked variability according to region, site, and operator. The purpose of this paper is to briefly review the current status of outcome-effectiveness projects in cardiology, present the complexity and key obstacles for more wide-scale application, and provide specific recommendations for cardiologists engaged in cardiac catheterization procedures to promote readiness for an important and unique era of medicine.